| print in portrait format if possible
Miles for Meals 5K Official Entry Form Name: _______________________________________ Address:______________________________________ City, State, Zip:_________________________________ Phone:________________________________________ email:___________________________________________________@_____________________________________ Sex:_____________Age on Race Day:____________ Race Division (check one only): 5K Run _________ 5K Walk_________ Entry Fee: (check only one) ________$20 Race Day (Includes T-Shirt while supplies last) T-Shirt size: (circle one if applicable) S, M, L, XL Make checks payable to:
"Miles for Meals c/o CCHOG" WAIVER: In consideration of the acceptance of my entry, I hereby waive on behalf of my heirs, executors and assigns, all claims of any nature arising from my participation in the Miles for Meals Run and do hereby release Cornerstone Church of God, Greg McCormick, SSNK and all sponsors, workers, officials and volunteers from any claim whatsoever arising from my participation in this event. I agree to abide by all the rules for participation, and acknowledge that the Race Director may refuse or return my entry at their discretion. I understand the risks for such a run and have trained adequately in preparation and I agree to pay for my own medical expenses in the case of an accident or illness regardless of whether I have autorized such expenses. I have noted any medical condition on the reverse of this form. I permit use of my name and picture in this event for publicity. ENTRY SIGNATURE:_____________________________________________Date: __________________ Parent's Signature (if under 18): ____________________________________Date: ___________________ Emergency Contact: __________________________________________Phone________________________ |